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Published on: April 11, 2025
Atrial Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging
Antonio Bisignani1, Luigi Pannone2, Alvise Del Monte3
1Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium; Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy. Electronic address: https://twitter.com/AntBisignani_MD.
Brugada syndrome (BrS) patients show prolonged atrial conduction times, suggesting concealed atrial cardiomyopathy. Ajmaline testing further revealed these electrical abnormalities, which predict atrial tachyarrhythmias (ATas) in BrS.
Area of Science:
- Cardiology
- Electrophysiology
- Genetic Cardiology
Background:
- Brugada syndrome (BrS) patients face elevated risks for arrhythmias, including atrial tachyarrhythmias (ATas).
- Underlying atrial cardiomyopathy may contribute to these arrhythmias in BrS patients.
Purpose of the Study:
- To evaluate atrial cardiomyopathy in BrS patients using electrocardiogram imaging (ECGI).
- To assess the impact of the ajmaline (AJM) test on atrial electrical properties in BrS patients.
Main Methods:
- ECGI was performed before and after ajmaline administration in BrS patients and controls.
- Total atrial conduction time (TACT) and local atrial conduction time (LACT) were calculated.
- Genetic analysis for SCN5A variants was conducted in BrS patients.
Main Results:
- BrS patients exhibited significantly prolonged TACT and LACT compared to controls.
- Ajmaline administration further increased TACT and LACT in BrS patients.
- Elevated TACT (>138.5 ms) independently predicted ATas in BrS patients with high sensitivity and specificity.
Conclusions:
- Prolonged TACT and LACT, exacerbated by ajmaline, suggest a concealed atrial cardiomyopathy in BrS.
- ECGI parameters like TACT are valuable for risk stratification of ATas in BrS.
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